RN Careers in North Carolina: Becomin an RN

A professional nursing career in North Carolina can in fact be multiple careers. There are many diverse areas of practice and even more diverse needs to meet. Registered nurses improve health at the population level as well as the level of the independent patient (https://www.ncbon.com/practice-registered-nurse). The most common setting for RNs nationwide is the acute care hospital. The roles they play within these facilities are expanding. Other work settings include skilled nursing facilities, home health agencies, dialysis centers, schools, adult care settings, and ambulatory care settings.

Among the current challenges are distribution of nurses within the state and difficulties meeting rural healthcare needs.

RN Scope of Practice

Registered nurses assess, plan, and carry out interventions and treatments. They also provide patient education and counseling and work toward prevention and maintenance of a wide variety of conditions. Unlike Licensed Practical Nurses, they are considered independent. RNs may count LPN supervision among their duties.

Periodically, the Board issues position statements clarifying what duties are considered appropriate for workers at different levels. Setting is a factor. A registered nurse employed by a dialysis center would be responsible for certain duties, including initial and pre-discharge assessments, but a number of duties could be carried out by LPNs or specially trained technicians. In a home setting, though, LPN or dialysis technician credentials wouldn’t suffice. An RN, working through a qualifying employer, would perform the procedure or teach it to an appropriate caregiver.

An RN can carry out a thorough physical assessment, but can’t make a medical diagnosis (https://www.ncbon.com/vdownloads/position-statements-decision-trees/history-and-physical.pdf). Some RNs progress as far as advanced practice and do diagnose illness and injury; North Carolina state law requires some level of supervision. The nurse practitioner role requires additional graduate education.

Practice is ever changing. RNs stay current on rules as well as current conceptualizations of best practice.

Becoming a North Carolina RN

RNs may enter the field with education at the bachelor’s or associate’s level (RN programs in North Carolina). The state is working, though, toward an increase in bachelor’s level RNs (https://www.ncha.org/healthcare-topics/workforce/workforce-resources); there are roles for those with different levels of preparation, but BSNs are considered better prepared for managing complex healthcare needs.

Jobs often require role-specific training. In many cases, this will consist of on-site orientation.

There are additional state-mandated requirements for nurses who take on the role of Sexual Assault Nurse Examiner (SANE).

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North Carolina Facilities

Large hospitals and health systems hire nurses into very specialized units. Roles can be specialized: for example, care coordinator and infection preventionist.

Nurses are team members. The Duke Life Flight team includes nurses with multiple specialties, working in concert with paramedics and respiratory therapists to provide life-sustaining care during transport. Nurses may hold certification in emergency care, critical care, and/ or flight nursing. They may have pediatric or neonatal specializations.

The WakeMed annual report describes utilizing two sets of critical care nurses: one bedside, one at a separate center, viewing data and images and serving as another pair of eyes.

North Carolina has 21 magnet hospitals. These facilities have a lot to offer patients and a lot to offer nurses as well. The state has two Pathway Designated facilities: CarolinaEast Medical Center and Nash Hospitals. The status indicates a nurse-friendly environment, though Pathway organizations do not need to meet all requirements that magnets do.

The large hospitals may beckon, but rural areas are in need of qualified professionals. The Sheps Center keeps track of closures – a big concern to those in rural health.

Critical access hospitals provide services to people who are not near large facilities. North Carolina boasts two critical access hospitals on the Top 100 list: Angel Medical Center and Transylvania Regional Hospital.

Hospitals and Nurses as Innovators

Hospitals carry out outreach in the community. One recent example was the Stop the Bleed educational event held at Mecklenburg County Courthouse (http://www.wsoctv.com/news/local/local-officials-learn-to-save-lives-through-stop-the-bleed-initiative/677272192).

It has become the expectation that hospitals will do more than provide acute care to people in health crises. They will take a role in preventing recurrence and indeed improving community health (https://www.northcarolinahealthnews.org/2016/03/04/rural-hospitals-embrace-population-health-in-quest-for-relevance).

Excellence is celebrated. The Duke Raleigh Hospital Mechanical Thrombectomy Program won a 2016 ‘Caring for Others’ award through the North Carolina Nursing Association. Two master’s level nurse leaders and a neurosurgeon brought an important issue to the attention of leaders: Their facility lacked a program in place to carry out procedures that are now considered best practice for some stroke cases (https://www.ncnurses.org/advocacy/workplace/best-practices). The nurses developed protocols and workflows. They educated staff from different departments and created simulations for workflow. Data showed times are good — with time being a very important factor for treating stroke. Other outcome measures also looked good.

Nurses below the graduate level may also identify problems and work for solutions. The Halifax Regional – Meds to Bed Program was a 2017 award winner. The problem here was that a medication considered best practice after stent placement could be difficult for patients to obtain. Patients were released home soon after treatment. Theoretically they had everything they needed, but in actuality they didn’t. Eventually, the team got a system in place where patients have their first dose before leaving and enjoy the benefits of drugstore delivery for a month. This time, credited team members included two bachelor’s level RNs and a CNA.

Average RN Salary in North Carolina

North Carolina has been projected to see 22% RN occupational growth across the 2014 to 2024 decade.

North Carolina registered nurses averaged $29.49 an hour or $61,330 a year for a 40-hour schedule.

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